An Adaptive Pragmatic Randomized Controlled Trial of Emergency Department Acupuncture for Acute Musculoskeletal Pain Management

Abstract

ABSTRACTObjectiveAcute musculoskeletal pain in emergency department (ED) patients is frequently severe and challenging to treat with medications alone. The purpose of this study was to determine the feasibility, acceptability and effectiveness of adding ED acupuncture to treat acute episodes of musculoskeletal pain in the neck, back, and/or extremities.MethodsIn this pragmatic two-stage adaptive open-label randomized clinical trial, Stage 1 identified whether auricular acupuncture (AA; based on the Battlefield Acupuncture protocol), or peripheral acupuncture (PA; needles in head, neck and extremities only), was more feasible, acceptable and efficacious in the ED. Stage 2 assessed effectiveness of the selected acupuncture intervention(s) on pain reduction compared to usual care only (UC). Licensed acupuncturists delivered AA and PA. They saw and evaluated, but did not deliver acupuncture to, the UC group as an attention control. All participants received usual care from blinded ED providers. The primary outcome was 1-hour change in 11-point pain numeric rating scale.ResultsStage 1 analysis found both acupuncture styles similar. Stage 2 continued all three arms. Among 236 participants randomized, demographics and baseline pain were comparable across groups. The diverse sample recruited was demographically reflective of the larger ED population. Estimated AA+UC (2.1; 95% CI: 1.6, 2.6) and PA+UC (1.6; 95% CI: 1.1, 2.1) 1-hour pain reductions were both significantly greater than UC (0.5; 95% CI: -0.1, 1.0), and participants in both treatment arms reported high satisfaction with acupuncture.ConclusionED acupuncture is feasible, acceptable and can effectively reduce acute musculoskeletal pain better than usual care alone.